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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The management of patients with chronic renal failure is complicated and demanding for both physician and patient, but is frequently rewarding. When specific treatment of the underlying cause is not possible, therapy is aimed at making the maximum use of existing nephrons and preventing further loss of nephrons through hypertension and infection. Careful attention to salt and water balance is necessary, and all patients and all drugs prescribed must be considered with care. Special problems exist with regard to anaemia, bone disease, pericarditis and hyperkalaemia. An important aspect of care at this time is the education of patients about the next major phase of management, dialysis and transplantation.
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PMID:The conservative management of chronic renal failure. 93 26

In five patients with chronic renal failure, rapid correction by dialysis of hypertension and/or high blood urea levels provoked acute neurological disorders, followed by slowly reversible neuropsychiatric disturbances. Focal EEG alterations were noted in three patients with normal carotid angiograms. Our cases differed from those usually described as suffering from the dialysis disequilibrium syndrome because of their duration, the severity of mental disturbances, and the asymmetrical pattern of EEG abnormalities. We propose that the symptoms observed could be due to cerebral ischemia. This possibility emphasizes the importance of limiting the duration and efficiency of the first dialyses in patients with severe hypertension and high nitrogen retention, especially if high performance dialyzers are used.
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PMID:Unusual aspects of the dialysis disequilibrium syndrome. 95 37

As a result of industrial and medical progress, man is exposed to an ever changing array of chemicals, drugs and biological products. The kidneys are extremely vulnerable to chronic toxic effects of these substances. Although acute renal failure, nephrotic syndrome and renal tubular disorders result from acute nephrotoxicity, chronic renal failure with renal failure and hypertension result from chronic nephrotoxicity. Heavy metals, analgesic agents and antimicrobials are the common nephrotoxic substance producing chronic renal disease. Medical management consists of preventive exposure measures and early detection of nephrotoxicity by modern industrial medicine. In addition, early clinical diagnosis with appropriate management may prevent the need for chronic hemodialysis and renal transplantation.
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PMID:Chronic toxic nephropathies--diagnosis and management. 96 94

Not all the varied clinical disorders in which aldosterone and the mineralocorticoid hormones are involved have been reviewed. Only those disorders in which the mineralocorticoid hormones and their regulatory factors are the principal cause of the biochemical and clinical abnormalities have been examined. These are many and varied. Appreciation of the extent and magnitude of their involvement in the regulation of blood pressure, body fluids, and electrolyte composition continues to grow. The major direct clinical impact of the mineralocorticoid hormones appears to be in two areas: hypertension and potassium homeostasis. Their part in the mosaic of hypertension is established in primary hyperaldosteronism, but they also appear to affect and modify the hypertensive process in primary or essential hypertension. The probe continues. Hypoaldosteronism is more than the rare occurrence associated with Addison's disease. It may be the clue to the presence of nonaldosterone mineralocorticoid excess syndromes, and is obviously of critical importance in an increasing number of patients with chronic renal failure of varied aetiologies.
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PMID:A perspective on aldosterone abnormalities. 97 45

Certain hemodialysis patients need to be made anephric, either surgically or physiologically. Bilateral renal infarction with shredded absorbable gelatin sponge (Gelfoam) was performed on a woman with malignant hypertension being maintained on chronic center dialysis who was too great a surgical risk for bilateral nephrectomy. Peripheral embolization complicated the procedure resulting in a forefoot amputation for dry gangrene two months later. Her postinfarction peripheral plasma renins remained elevated, and she remained hypertensive but was more easily managed with fewer drugs. This technique has been successfully used by others in 1 patient with chronic renal failure and heavy proteinuria and another with hypertension and a solitary kidney. If, as in our case, postinfarction plasma renins remain elevated and hypertension persists, bilateral nephrectomy could be performed at a later date or infarction could be repeated.
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PMID:Treatment of uncontrolled hypertension by therapeutic renal infarction. 99 56

The angiotensin antagonist saralasin (1-sar-8-ala-angiotensin II) was given to 27 patients with different forms of secondary hypertension. The blood pressure fell in 6 of 7 patients with renal artery stenosis and in 4 of 10 patients with terminal renal failure on regular hemodialysis. No change or a rise in blood pressure was observed in 3 patients with Cushing's syndrome, 4 patients with primary aldosteronism, 3 patients with hypertension and a unilateral small kidney of other than renovascular origin, and 6 patients with terminal renal failure. It can be concluded from the results that angiotensin II is involved in the pathogenesis of renovascular hypertension and in some cases of hypertension accompanying chronic renal failure.
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PMID:[Effect of the angiotensin antagonist saralasin (1-sar-8-ala-angiotensin II) on the blood pressure in secondary hypertension]. 101 96

1. The anti-hypertensive effect of converting enzyme inhibition was evaluated in twenty-three hypertensive patients (seven renovascular, four essential, four malignant, one scleroderma, three chronic renal failure, four primary or idiopathic aldosteronism). 2. In sixteen patients a single injection (1--4 mg/kg) of the inhibitor produced an immediate anti-hypertensive effect, which lasted up to 16 h. In six patients the anti-hypertensive effect of the inhibitor was significantly improved after sodium depletion. 3. Plasma renin activities increased and plasma aldosterone concentrations decreased consistently except in idiopathic aldosteronism. 4. Converting enzyme inhibition provides a direct way of defining the degree of renin-dependency of the hypertension. Accordingly, it can be used diagnostically and for planning appropriate therapy. Therapeutically, it could be advantageous in hypertensive emergencies because of its safety, specificity and capacity to reduce aldosterone secretion.
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PMID:The use of angiotensin-converting enzyme inhibitor in the diagnosis and treatment of hypertension. 107 92

Accelerated hypertension with end stage renal failure not responsive to hemodialysis and ultrafiltration was an indication for bilateral nephrectomy in 22 patients, five of whom required the procedure as an emergency. Normotension occurred in every patient after removal of the kidneys, but hypertension returned in 12 persons after renal transplantation. Five of these required long term antihypertensive medication, and in an additional seven, some form of diuretic was necessary. There were no distinguishing features among those patients in whom post-transplant hypertension developed from those in whom it did not. In spite of severe accelerated hypertension in the patient with well documented chronic renal disease, prompt nephrectomy and renal transplantation were compatible, with an 86 per cent patient survival rate. Seventy-seven per cent of the kidneys functioned for an average of 29 months.
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PMID:Treatment of accelerated hypertension and end stage renal failure by bilateral nephrectomy and renal transplantation. 109 1

In seven patients with chronic renal failure in an advanced stage 17 episodes of upper abdominal pain, hypertension, vomiting and (in some of them) coma occurred during peritoneal dialysis with sorbitol-containing dialysate. The signs recurred in some of the patients but did not when glucose-containing dialysate of otherwise identical composition was used. Very high levels of sorbitol in CSF and serum were measured in the comatose patients. The precipitating factor is probably a reduced metabolic breakdown of sorbitol in renal failure with preferential intracellular deposition of sorbitol and subsequent cellular oedema. To avoid this dangerous reaction it is necessary to use glucose instead of sorbitol in peritoneal dialysates, despite the technical problems of sterilisation. Where this is not possible, glucose should be added in order to reduce the sorbitol concentration in the dialysate to less than 15g/l.
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PMID:[Severe side-effects during peritoneal dialysis caused by sorbitol-containing dialysate (author's transl)]. 114 25

"Overloading" with salt and water, i.e., increasing extracellular fluid, can, if maintained for a period, lead to hypertension in which the main hemodynamic abnormality is increased peripheral resistance. There is evidence that salt and water overload is the chief factor in the hypertension of the majority of patients suffering from chronic renal failure. "Overloading" occurs not only when the contents of a container are increased, but also when the capacity of a container is decreased. Reduction of the compliance of the interstitial space would reduce its capacity to hold fluid without increase in pressure. Evidence is presented that the presence of the kidney affects interstitial space compliance; bilateral nephrectomy decreases interstitial space compliance four fold. Hypertension induced by renal artery partial constriction and removal of the other kidney is also associated with reduction of interstitial space compliance; a sudden rise in interstitial space compliance may be the primary factor in the course of events that leads to the rapid fall in blood pressure which occurs when the constriction is removed from the renal artery. It is suggested that the kidney secretes a hormone which increases interstitial space compliance and that this represents a physiological mechanism which enables animals to store water in the interstitial space without undue rise in interstitial tissue pressure. The role of this mechanism in hypertension and in chronic renal failure is discussed.
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PMID:Renal control of interstitial space compliance: a physiological mechanism which may play a part in the etiology of hypertension. 119 16


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